OP-ED

Angry Nurses Tell of Ebola Patient’s arrival at Texas Hospital

Texas Health Presbyterian

A group of nurses at Texas Health Presbyterian has come forward with a very different picture of what happened when Liberian Ebola patient Thomas Duncan arrived at the hospital with Ebola-like symptoms on September 28th.  If true, the allegations are certainly unsettling.

In an unusual move, the nurses spoke anonymously to the media, conducting a blind conference call in which none of the participants were identified.

After arriving at the emergency room with a high fever and other symptoms of the disease , the nurses said the patient was kept in a public area, despite the fact that he and a relative informed staff that he had been instructed to go to the hospital after contacting the Centers for Disease Control in Atlanta to report a possible case of Ebola.

The nurses said the patient was  “left for several hours, not in isolation, in an area” where up to seven other patients were. “Subsequently, a nurse supervisor arrived and demanded that he be moved to an isolation unit, yet faced stiff resistance from other hospital authorities,” they alleged.

Duncan’s lab samples were sent through the usual hospital tube system “without being specifically sealed and hand delivered. The result is that the entire tube system … was potentially contaminated,” they said.

The statement described a hospital with no clear rules on how to handle Ebola patients, despite months of alerts from the Centers for Disease Control and Prevention in Atlanta about the possibility of Ebola coming to the United States.

“There was no advanced preparedness on what to do with the patient. There was no protocol. There was no system. The nurses were asked to call the infectious disease department” if they had questions, but that department didn’t have answers either, the statement said. So nurses were essentially left to figure things out on their own as they dealt with “copious amounts” of highly contagious bodily fluids from the dying Duncan while wearing gloves with no wrist tapes, flimsy gowns that did not cover their necks, and no surgical booties, it alleged.

The charges come on the same day as news that a second healthcare worker has tested positive for Ebola. Frieden said public health officials should prepare for the worst, saying that it is likely that more cases will emerge.

The CDC Director issued a series of statements yesterday admitting that the agency was slow in responding to the crisis. Frieden backtracked on statements that many nurses interpreted as throwing the nurses involved under the bus. The agency is reassessing its guidance on the disease.

Nurses and their supporters took to Twitter to defend the nurses involved.

Screen Shot 2014-10-15 at 10.17.46 AM

Note: You can read the CDC’s original guidance to health care workers  in Frieden’s THCB blog post here.

Update : Revised guidelines call for extra precautions to be taken to cover exposed skin, second layer of gloves.

New Ebola PPE

If you are a nurse involved in the care of a patient at Texas Health Presbyterian, we’d like to hear your side of the story. E-mail us.  We’re also interested in hearing from other nurses around the country. Has your hospital established procedures and guidelines for dealing with potential Ebola cases?

Pick up the story from the Dallas Morning News here

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125 replies »

  1. This is a really good tip particularly to those fresh to the blogosphere.
    Short but very accurate information… Thanks for sharing this one.
    A must read article!

  2. Vendors know that they are not to sell medical devices without FDA approval. How it came to be that EHR, CPOE, and CDS are being used to diagnose and treat disease without approval by the FDA is a matter for investigation.

    Those who have allowed this, giving the vendors of EHRs a pass from oversight, have Mr. Duncan’s blood on their hands.

  3. The facts indicate that the EHR was true to form, causing errors that would never have occurred with the highly evolved safety net that was replaced by the user unfriendly, time consuming, flawed EHR.

  4. What makes John think that Kincannon was speaking for the Tea Party? Oh, he made that up. …and he also made up the claim about his annoyance over the comments being made and how the thread refuses to die. If he wanted the thread to die he would have not written such nonsense.

    We wait to hear why what Senegal did to become Ebola free is so wrong.

  5. This thread refuses to die. Every day I delete notices from my inbox for yet another bunch of comments at this post. Most are spam (which keep the blog moderators busy) but many are just ongoing yammering. Please, folks, put a sock in it. Give it a rest. Some here may have a bright futures asTea Party activists, like South Carolina’s Todd Kincannon.
    http://aattp.org/pro-life-tea-party-christian-todd-kincannon-execute-all-ebola-patients-screenshots/
    I came across a new twist on an old axiom — You can show some folks the facts but you can’t make them think.
    If the shoe fits… you know the rest.

  6. The death rate from this strain of Ebola is now said to be around 70% and that doesn’t count the deaths that never make it to be counted.

    We will be able to judge how good American care is when we see how many of those that get Ebola die. Hopefully the number will not be statistically significant.

    What country has put in more dollars than the US in trying to find a vaccine and/or a cure? Can you tell us the answer?

    What was wrong with Duncan’s care? What was wrong was the care for others around him. That is a problem when something new suddenly appears and the experts stay in DC.

  7. Gina, you must love the job we are doing today as immigrants enter and even when stopped are left free to go. Silly way you seem to be looking at things.

    Ellis Island was for the poor folk coming in from Europe. Not silly as over 12 million people were processed there and held if they were found to carry infectious disease. Others from Europe came with more finances and were processed differently, but health concerns were a priority.

    Before 1954 I wonder how many Canadians per year came to the US and (per year) how many people actually immigrated to the US through Canada and Mexico without being evaluated. Are you able to educate us on these facets of immigration?

    Did you not realize who went through Ellis Island and that medical checks were done?

    It wasn’t till a lot later that our immigration policy changed and we started to discriminate against Europeans and the like that were educated.

  8. Not all Immigrants went through Ellis Island (stop using such silly stuff as an example) – a lot of Immigrants got off in Mexico and Canada and just walked across. I rather we track them, then scare them into hiding and sneaking in.

  9. Funny how NO ONE CARED about ebola (even though it’s been on TV every night since August) until it landed here. Keep in mind the the U.S. outbreak started in Texas at a “supposed” state of the art hospital. If I knew we had an ebola patient – I would have read up on everything I could about it after seeing how those nurses in West Africa had been suited up and sprayed down—-then have our hospital tell me to just put on a gown and mask——no way would I have gone in there. Common sense people.

  10. Stop making Ebola political! Get a grip. Like that would really stop people from coming to the US. It would be even more alarming knowing people were sneaking in and not be able to track them. Let’s stop all flights out of Texas or anyone leaving or transporting things from Texas. Does that sound logical?

  11. Peter1 writes: “Tell you what Allan, if Canada has an epidemic of Ebola I’ll support a travel ban.”

    Typical low level thinking of leftist ideology on many fronts.

  12. You totally miss the point. I provided a methodology and you provided an editorial that is talking about the rhetoric being used. That is a typical ideological response by one that doesn’t have an answer.

    What is wrong with the methodology I presented? What is wrong with the methodology used by Senegal and Nigeria that are becoming Ebola free?

    You don’t have an answer so you post an editorial that is not on point.

    We don’t know if we will have another case or not. What we do know is that one case has caused hundreds to be cautioned, two nurses to be hospitalized, a large hospital being compromised, an airline to be placed in jeopardy plus placed with a lot of costs, an airline industry that could be badly hurt along with the downstream effects to the economy and probably in the millions of dollars in costs for one patient.

    Maybe no more carriers of Ebola will enter again and that will prove that the caution was unnecessary *retrospectively*, but if it turns out that more enter we have to multiply the negative effects by the number of entries to provide an approximate cost which would be at the lower end of the spectrum.

  13. Peter1, a well known and well practiced proven methodology is not political. What is political are your accusations.

    What is the evidence that the above is not the best way to protect this nation? You don’t have any.

    The reason Obama has decided to do what he has done is for political reasons and that might be rational, but his rational that we don’t want to make the people feel trapped is not well grounded for the nations surrounding the hotspots have sealed their borders and two will soon be considered Ebola free.

    We must protect our resources to protect our citizens and to protect our efforts to aid these nations.

    Those nations that have sealed their borders have done more to end the Ebola outbreak than any of our efforts so far.

    All that I am saying is based upon logic and common sense, but sometimes the ideological driven prefer dreams and their religion of the left to reality.

  14. “Politics is dominating common sense and it is dulling the intellect of those that suck it up.”

    “This has nothing to do with politics.”

    ?

  15. Peter1, it is not the true conservative right that requires zero risk rather the left that almost always uses anecdotes to prove a point. Zero risk cannot be obtained, but one can attack the bulk of the risk and that is what it seems you fail to understand.

    This has nothing to do with politics. It only has to do with common sense. The third world nation of Senegal will shortly be considered Ebola free followed by the third world country of Nigeria. How did they do that with their third world technology?

    They sealed their borders and intensively followed every one in contact with the virus.

    These third world nations see to have something we don’t. Common Sense!.

  16. Allan, you and the frantic Right (pre Nov 4) are calling for travel restrictions based on nothing but location, location, location – no matter the risk.

    How do you know what risk is posed by the Ebola State – Texas? Don’t you want zero risk?

  17. Bobby, it appears that Duncan knew he was probably infected and what did he do? Where is the best technology and care to prevent death from this disease? The US.

    Duncan a trained individual hopped a plane to the US. People that are dying will do a lot to remain alive.

  18. Peter1, we are not discussing persons that have little to no risk. We are talking about real risk and real lives. As stated below Doctors Without Borders has lost 9 of their staff and have 16 infected.

  19. You might be right John that there is a polar vortex because I am compelled to agree with you. I think that some of the louder voices don’t disagree either except rightfully they believe the border should be shut/controlled with regard to non American citizens from the hotspots of those nations. We have the facilities to manage Ebola once we get our act together.

    Look at the havoc one Ebola patient caused. Disruptions to the airline industry and all the industries downstream can have a similar effect. School closures in the areas. Hundreds of people in isolation. A major hospital’s ER shut down because of fear and nursing shortages. What happens to those patients that require intensive care when they become sick with other diseases and there are inadequate facilities to treat them?

    Take note that this disease though controllable in this country needs to be limited as much as possible and that means control of the borders. Also take note that Doctors Without Borders is a trained group and they have lost 9 members to Ebola and have another 16 members of their staff infected. The answer is simple. We should not panic but we should control entry to those in Ebola ridden areas and isolate anyone who might be infected. (isolation and quarantine are different)

  20. Governor Rick Perry is now calling for a travel ban. I agree, we should not let Texans travel outside the state since their medical system is incapable of containing their “outbreak”.

    Barricades should be placed at all roads crossing state lines, air travel should be blocked from leaving texas and train service outside the state ended. Since cows may contract the disease no Texas beef should be sold outside the state.

    Better to take necessary precautions than panic.

  21. That is in the coverage machine. The coverage asks the usual pundits the usual blame questions and they get the comments for the momentary news cycle.

  22. There may be a polar vortex in Hell because I am compelled to say say Thank you to National Review Online and Shep Smith of Fox News. Anyone familiar with my politics (unreconstructed Sixties Liberal) knows I have a deep-rooted antipathy for both. But it’s only right to recognize when they get something right.

    The link is easy to find. Read for yourself as they point out something blindingly clear:

    Despite the fever-pitch nature of televised Ebola coverage, there are exceptions. On Fox News, anchor Shepard Smith went out of his way to provide context for a reporter’s conclusion that Ebola was causing “widespread panic” across the country.

    “I think we both know there’s no widespread panic across the country,” Smith responded before turning to the camera to address the TV audience directly.

    “You should have no concerns about Ebola at all. None. I promise,” Smith said. “Do not listen to the hysterical voices on the radio and the television or read the fear-provoking words online. The people who say and write hysterical things are being very irresponsible.”

    But as for his show, Smith said, “it’s not worth the ratings and it’s not worth the politics” to say Ebola is an imminent danger when the day might come when a real panic hits.

    “We do not have an outbreak of Ebola in the United States. Nowhere. We do have two health-care workers who contracted the disease from a dying man. They are isolated. There is no information to suggest that the virus has spread to anyone in the general population in America. Not one person in the general population in the United States.”

    Would that more of Smith’s colleagues in the media followed his lead. Concern is one thing, but raw, unreasoning fear is something that must be combatted as a public service.

  23. Since the U.S. can’t get their act together, perhaps we should find some real health care professionals (from Africa) who are equipped to work with ebola patients, to train our U.S. staff.

    Since September all the nightly news channels have been showing how “suited” up the African healthcare workers are and how something as simple as washing your hands, etc – can kill the virus.

    Why the nurse would board a plane – even with a low grade fever – after having worked around Mr. Duncan, I don’t care what the CDC told me – I would not expose my family or anyone else.

    I have little faith in healthcare workers in Texas right now. I would have read everything on ebola and what precautions to take for my own safety, then alerted the news if not given the correct protective gear required. The whistle blower and others, need to accept some blame here.

    Common sense, people!

  24. peter1: “although having the CDC there would have helped.”

    If you read my comments you would see that is what I expected of the CDC. I also expected them to make sure the hospital was prepared. My understanding is that this is a good hospital with good staff. The CDC told the patient to go to the hospital and should have notified the hospital in advance along with checking on needs. I would have strongly considered sending the CDC to the hospital and also considered transferring the patient to Emory or the hospital in Nebraska.

    Instead the CDC made all sorts of comments that tried to meet the political needs of the moment. It sounded as if they were flipping coins.The CDC contradicted itself and the President while continually backtracking. The way to stop panic is to get ahead of the situation.

    I do not believe we will have an epidemic of ebola in this country. We might have sporadic outbreaks. I want to reduce those outbreaks as much as possible so that we do not have to impose isolation or quarantine on so many Americans. I also want to reduce the number of hospitals involved because hospitals are not overstaffed and this one patient took too many of the staff away from their other duties. The hospital will have difficulty hiring more staff because of ebola. That means we risk having areas not adequately covered for emergency medical services. Thirdly the costs for one patient are horrendous. Finally this has economic impact. My bet is the airline industry will suffer tremendously if we find another patient with ebola on a plane and this has further impact on other sectors of the economy. The fears do not have to be rational to cause the economic impact I am talking about. Decisions that appear political even if correct decisions exacerbate the problem and in this case the decisions were either openly political or lacked a sense of mission

    My views on this topic are not political. They are simply practical and represent common sense.

  25. “The first link showed the equipment to be used for level 4 pathogens.
    The second link showed that ebola was considered a level 4 pathogen.”

    You said the hospital did NOT have the right gear. The hospital said they had what CDC prescribed – which I assume was the “level 4” equipment.

    Just because a nurse has trouble getting used to the equipment is not the fault of CDC – although having the CDC there would have helped.

    You argue in circles like the March Hare.

  26. Seigel is taking an all or none view of the situation. I have heard him before and he becomes flummoxed when others explain a ban need not exist as charter flights and military aircraft could be used. Isolation could also be a solution and is presently being used in the US with American citizens that have become exposed to the virus.

    No one can predict the future so one should be cautious and recognize that each case causes many Americans to face isolation, hospitals to close their doors and send ambulances elsewhere along with immense amounts of spending that could be better used in fighting the disease.

  27. “Sadly, it has reached the point where we will not feel safe unless we ban travel to and from Liberia, Sierra Leone, and Guinea. The reason this is a sad moment is that there is a good chance it could interfere with the flow of health care and resources to and from these countries. Not only that, but, historically, when a country suffering from a growing epidemic has felt cut off from the rest of the world, the fear quotient has risen, and people afraid of the contagion have attempted to flee. Unfortunately, when people hastily attempt to escape imposed restrictions, they tend to take fewer precautions, which increases their chances of catching the dreaded disease.

    But first and foremost, although we are members of the world health community, we must worry about our own public psyche here in the United States. If our leaders can’t give us a sense that we are protected, we must achieve it by imposing a ban.”

    – Marc Seigel, MD, National Review

  28. Did you not link to the CDC recommendations that I posted?

    The first link showed the equipment to be used for level 4 pathogens.

    The second link showed that ebola was considered a level 4 pathogen.

    The article showed how the nurses had to keep catching up. Even their necks were not initially covered. It is not easy to remove a contaminated gown. All of this takes practice and thought, but there are lots of distractions when one is faced with a dying patient.

  29. “I don’t understand what you are trying to point out.”

    You said:

    “The protective gear is not made for this type of infection. The gear is not made for this degree of protection nor is the supervision.”

    I linked to the hospital statement that said the gear they used was CDC prescribed for eboa.

    Why is it so hard for you to understand the obvious?

  30. Absolutely! He is so right.

    That is a reason we are a Constitutional Republic. That is the difference between the American and the French revolutions. The masses despite their education, class, or whatever in a democracy can with 51% of the vote, vote the other 49% into slavery.

    In any event thank you for bringing up his name and thoughts which are somewhat buried in history.

  31. Peter1, I don’t believe this was a political plot. The editors have been quite open from what I have seen so I suspect it has nothing to do with politics.

    In any event I am glad you were able to get the CDC links I sent.

  32. Peter1, my response to you that provided the CDC’s own methods of handling level 4 pathogens is still being held by the moderator for some unexplained reason.

    I don’t understand what you are trying to point out. I am sure the nurses did the best they could with their training and the facilities available. If you note some of the earlier actions were not consistent with how level 4 pathogens are handled by the CDC. You will also note that there was a progression in safety provisions.

    Ebola is new or relatively so to the staff at that hospital. I believe the CDC should have been more proactive and careful.

    When nurses become contaminated it causes that particular hospital to be less available to the community. It also drains our resources. That is why I believe we should do everything possible to prevent ebola from entering the country. If we cut down potential risk by 50% then 50% less money will be sent and 50% less hospital doors would be closed.

  33. “Why was my comment placed on moderation”

    I have found that more than one link puts you in moderation.

    Unless it is a liberal plot, better look closer.

  34. Yeah. But it has nothing to do with her elsewhere recent assertion that Epic EHR caused the Texas Duncan Ebola death. Moreover, her claims (~13.00-ish) regarding the safety of paper charts is overstated.

  35. It was! To illustrate that public institutions are not value neutral, but depend on the wish of the public (the masses).

  36. Why was my comment placed on moderation when it was on topic and even provided two CDC sites that demonstrated what type of precautions needed to be taken?

  37. Allan says:

    October 16, 2014 at 7:23 am
    Peter1 writes: “Show me. And whose politics”
    Plain generic politics.
    It is stupidity when one places national security and the security of the American people at jeopardy because of politics.
    You want proof. I provided some below in a list that states some of the errors, but the real proof is at the CDC where one can read how level 4 pathogens are supposed to be handled.
    http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf
    http://www.cdc.gov/training/quicklearns/biosafety/
    Those are the rules the CDC sets for itself and they are dealing mostly with pathogens that are in petri dishes, not generally in patients that are vomiting and excreting virulent pathogens through every orifice of their bodies.
    We are quarantining Americans now, but won’t quarantine those coming from ebola infected areas.
    I don’t give a hoot about politics when national security is the issue. Apparently from some of what I read that is all what some think about when they try and bend the news.
    We have had experience in quarantine. Until 1954 immigrants would go through Ellis Island. Why do you think that was done? Do you think they were throwing a party?
    REPLY

  38. Why is this above comment awaiting moderation?

    Allan says:
    Your comment is awaiting moderation.
    October 16, 2014 at 7:23 am
    Peter1 writes: “Show me. And whose politics”
    Plain generic politics.
    It is stupidity when one places national security and the security of the American people at jeopardy because of politics.
    You want proof. I provided some below in a list that states some of the errors, but the real proof is at the CDC where one can read how level 4 pathogens are supposed to be handled.
    http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf
    http://www.cdc.gov/training/quicklearns/biosafety/
    Those are the rules the CDC sets for itself and they are dealing mostly with pathogens that are in petri dishes, not generally in patients that are vomiting and excreting virulent pathogens through every orifice of their bodies.
    We are quarantining Americans now, but won’t quarantine those coming from ebola infected areas.
    I don’t give a damn about politics when national security is the issue. Apparently from some of what I read that is all what some think about when they try and bend the news.
    We have had experience in quarantine. Until 1954 immigrants would go through Ellis Island. Why do you think that was done? Do you think they were throwing a party?
    REPLY

  39. “Peter1, you demonstrate pure ignorance. Nurses are trained to prevent transmission of disease to the patient and to a lesser degree to themselves and others. Others down the chain even have less training. The protective gear is not made for this type of infection. The gear is not made for this degree of protection nor is the supervision.”

    I guess my link was for you Allan, not V-I-K.

    http://www.star-telegram.com/2014/10/15/6202585/ebola-risk-cdc-looking-for-passengers.html

    “• When Mr. Duncan returned to the Emergency Department (ED), he arrived via EMS. He was moved directly to a private room and placed in isolation. THD staff wore the appropriate personal protective equipment (PPE) as recommended by the CDC at the time.”

  40. We’ll be featuring a post on the EHR story from Deborah & her Patient Privacy Rights group a little later this morning, should be coming in shortly …

  41. Saurabh, thank you, but it doesn’t seem to me that the address you provided is the address you wanted me to read.

  42. It’s V-I-K.

    Yes, Peter1, 1976 is such an apt corollary because there was so much international passenger traffic back then, just six years after airline deregulation. There was about 1/10th the volume of passenger traffic that there is today.

    Magnitude matters.

  43. That is true, but when one’s political opinions appear more faith based or similar to religion we know the thinking process has been turned off.

    Post hoc justification is common and we have been seeing a lot of that lately. That is a part of the nature of man.

  44. Everyone thinks he is a thinker these days. This is the curse of a rational society. Except what we think is “thinking” is merely post hoc justification of our priors.

    See my last response to BG.

  45. Nice one!

    I think we all need to take ourselves less seriously to think with more clarity.

  46. John, this isn’t “progress” it is pure politics by a President that is out of his league.

    The way one can prove this is by reading the CDC manuals. I posted two http’s for the CDC.

    One can also prove this by watching the videos of the President and listening to the videos of Frieden. They contradict themselves, each other, their underlings, common sense and the CDC procedures.

    Ellis island was intended to prevent disease from spreading into America. It wasn’t a political plot and it wasn’t an image. It was reality, something seemingly lost in your dreamy musings. All immigrants went through Ellis island or another similar checkpoint and were not let in with disease like tuberculosis.

    Start reading the CDC’s own manuals.

  47. You are a funny chap! For the sake of balance, we need irreverence on the right as well

  48. Peter1 writes: “Show me. And whose politics”

    Plain generic politics.

    It is stupidity when one places national security and the security of the American people at jeopardy because of politics.

    You want proof. I provided some below in a list that states some of the errors, but the real proof is at the CDC where one can read how level 4 pathogens are supposed to be handled.

    http://www.cdc.gov/biosafety/publications/bmbl5/bmbl5_sect_iv.pdf

    http://www.cdc.gov/training/quicklearns/biosafety/

    Those are the rules the CDC sets for itself and they are dealing mostly with pathogens that are in petri dishes, not generally in patients that are vomiting and excreting virulent pathogens through every orifice of their bodies.

    We are quarantining Americans now, but won’t quarantine those coming from ebola infected areas.

    I don’t give a damn about politics when national security is the issue. Apparently from some of what I read that is all what some think about when they try and bend the news.

    We have had experience in quarantine. Until 1954 immigrants would go through Ellis Island. Why do you think that was done? Do you think they were throwing a party?

  49. There should be NO Surgeon General. The position is an anachronism has not been occupied by a physician with integrity since C. Everett Koop.

  50. “Ebola is becoming the new Benghazi”

    The blame insanity is strikingly bipartisan in this country.

  51. In some ways l’affaire Ebola illustrates political polarization more than any medical or scientific questions. The facts are neither obscure nor insurmountable. Records of hemorrhagic fevers go back many years, but this time it appears that something about what we like to call progress has allowed it to get out of control.

    I’m reminded of fire-retardant chemicals that cause cancer in children’s pajamas and new toxic vapors for fire-fighters. And that reference to the Ellis Island hospital surrounded by water reminds me of the president’s image of a moat on the Southern border — with alligators. I have no idea why the disease got out of control this time, but it may be related to nearly a decade of civil war in Liberia — that well-intentioned but misbegotten American experiment in returning black people to Africa.

    Meantime, a political fight over who will become the next Surgeon General is under way, and Ebola is becoming the new Benghazi — a handy cudgel to wield at the administration as we approach a mid-term election and the final two years of a lame duck presidency.

    My hope is that somewhere in the fog that technical and humanitarian support Vic mentioned is under way. I have nothing further to add to this discussion.

  52. Have we blamed Bush Jr yet for Ebola?!

    Perhaps it was Stanley’s journeys in to the Congo!

    Oh, wait it’s the 1 %. Occupy Ebola.

  53. ” The problem is that politics and stupidity have gotten in the way.”

    Show me. And whose politics, Obama’s, Republican, Fox News, Nov 4th elections?

    The CDC, which has made some missteps (but they aren’t stupid), I think in trying to prevent irrational panic, is not the caregivers. The local hospitals are the caregivers – are they “stupid”? They deal with infectious disease, isolation, worker safety and patient safety every day. The CDC can only advise, and warn.

    The CDC did not allow Mr. Duncan to go home from the ER and it seems Tom Frieden could have ordered a response team to the hospital after his re-admission. All this screaming for the first ebola patient in the U.S. since 1976.

    I’m not panicking, why are some of you, for politics?

  54. “Vic, ebola has been around since about 1976.”

    Peter1, you demonstrate pure ignorance. Nurses are trained to prevent transmission of disease to the patient and to a lesser degree to themselves and others. Others down the chain even have less training. The protective gear is not made for this type of infection. The gear is not made for this degree of protection nor is the supervision.

    Look at the CDC rules for level 4. The CDC uses a completely different set of gear and procedures and they deal with Ebola in a petri dish not coming from every orifice a patient has and not being thrown at them in the form of vomitus.

    Politics is dominating common sense and it is dulling the intellect of those that suck it up.

  55. Vik, you are entirely correct. I’ll bet somewhere in the CDC files there is a manual which describes how to handle such situations and that your #1 is the #1 in the book. I know history is boring, but how many people on this list have families that came to this country before 1954. That is the date Ellis Island closed. There was even a hospital on that island surrounded by water, immigration hospital. One wasn’t permitted entry into the nation if ill.

    As usual hubris and politics entered the picture and now we permit entry to all sorts of diseases including drug resistant tuberculosis. Today we have a government that is so politicized it is willing to place American citizens into quarantine, but lets non Americans enter with disease.

  56. John, you say “getting there, little by little. A learning curve..”.

    The problem I see is that technologically we are there and have been there for decades. The CDC deals with these types of pathogens all the time. The problem is that politics and stupidity have gotten in the way.

    The CDC protects its personal with gowns and respirators specifically designed against pathogens. The CDC is dealing with ebola like pathogens in petri dishes while the nurses wearing insufficient protective gear treat patients vomiting all over expelling liquids from all over the body. We have specialized units to deal with this type of problem, but the CDC originally was there not to help, but to smooth out the political turmoil that travels with the disease and though they are now more involved they still have their eyes set on the political winds.

    It appears the young woman that you point to in the video has more common sense than the CDC and our President.

  57. Vic, ebola has been around since about 1976. How many travelers and trips have occurred since then and we’ve had no reason to panic, as you seem to be doing.

    We know how to diagnose, treat, trace, protect health workers and isolate. Getting to the source in Africa seems to be the best strategy as well as vigilance here.

    The case here in U.S. was because of hospital errors from an institution which should know how to deal with all sorts of infectious diseases. The disease is spread from direct contact with bodily fluids, not airborne. HIV patients also had to deal with uninformed and ignorant reaction from the public which hampered its control early on.

    Maybe you feel internment camps for travelers and isolation of an entire region is the best defense but I hardly see that as the intelligent reaction from someone who appears to be educated.

  58. I did not get to complete my comment above, thanks to THCB’s antiquated comment mechanism, which still doesn’t allow me to edit a comment or like/dislike. Hence, I will finish it here.

    You are staggeringly ignorant about infectious disease. Go read some history of HIV/AIDS and then come back and comment.

    The Administration’s major tasks in this crisis were to: 1) prevent the emergence of patient 0 on US soil, if at all possible; and 2) if #1 cannot be achieved, demonstrate seriousness of purpose and strategy to build confidence amongst Americans. Optics and perception are crucial.

    Thus, my report card:

    Strategy = FAIL
    Tactics = FAIL
    Optics = FAIL
    Communication & messaging = FAIL

    The way to avoid onerous and expensive strategies and tactics is to avail yourself early and often known and available tools that should be used first. (i.e., ban flights to and from affected nations and then send those nations all manner of technical and humanitarian support).

  59. We can be grateful to possess the resources that associate with living within the world equivalent of a gated community, not like the nurse during this story World Health Organization had to create do with no matter she might realize.

  60. You are staggeringly ignorant about infectious disease. Go read some history of HIV/AIDS and then come back and comment.

    The Administration’s major tasks in this crisis were to: 1) prevent the emergence of patient 0 on US soil, if at all possible; and 2) if #1 cannot be achieved, demonstrate seriousness of purpose and strategy

  61. Positive suggestions:
    1)Stop all non Americans entry from West Africa unless proven free of disease or unless part of a recognized team treating Ebola.
    2)When a patient like Duncan calls the CDC don’t just tell him to go to the hospital. Notify the hospital that a suspected case of Ebola is arriving and needs strict isolation. Also supply the needed advice on how to protect staff and other patients.
    3)The CDC should immediately send someone to the site to observe procedures
    4)Gowns should be provided that are appropriate for Ebola and cover all parts of the body.
    5)Apparently the first nurses were faced with insufficient gowns and other protections. Yet they were faced with vomitus and large amounts of contaminated liquids.
    6)The CDC uses spotters to help a person gown up and remove the gown.That is not standard in hospitals.
    7)Be accurate, the public needs to be able to trust the CDC. While Frieden was blaming the nurse for flying when she shouldn’t have, typical blame game, he should have known that the CDC gave her permission according to a recent report.
    8)I wonder why people don’t immediately shower after removing the gown?
    9)Why weren’t the specialized hospitals built specifically for diseases like Ebola used for Duncan?

  62. “For crying out loud, will somebody start advancing a few positive suggestions how best to get this outbreak in West Africa under control”
    __

    Nah. Far more entertaining to tear down those actually doing the work. Blame Epic, blame CDC, Blame Obama — in fact, call it #Obola (trending hashtag).

    We don’t WANT it controlled. Here.

  63. I can only speak for myself, but all these email notices of sniping and blaming are getting on my nerves. I just came across a link to a WSJ piece talking about the “twilight of public institutions” followed by a string of armchair experts having a great time blaming the Obama administration (as usual) as though this disease outbreak is the result of government policy. Already a Web search for “Ebola conspiracy theories” returns about seven million links! (Only about forty thousand if you use quotation marks.)
    This is what I left at that link…

    Both CDC and WHO have fallen short of best case responses to the Ebola outbreak. But in fairness, both have had to walk on eggs so often that an aggressive response from either would be out of character and would come as a shocking surprise. In both cases they have ultimate responsibility (read “blame”) for any mistakes but neither is authorized to force anything out of the ordinary to happen. Like so many large organizations their roles are part symbol and part action. Neither is authorized to order anything to happen. Theirs is the universe of persuasion, suggestion, emphasis, public relations.

    If WHO had the authority required to fulfill its putative mission malaria and TB tracking and treatments would be light years ahead. The CDC’s role is part research and part tracking, but again, if it had the kind of control required to complete its mission, it would not be so loaded with red tape and legislative limitations that the crisis now unfolding would not have been as dramatic as it has been. One of the glaring limitations that comes to mind in the case of CDC is the prohibition that it is forbidden to track and record firearms statistics, thanks to the political power of the NRA. I’m not aware of what limits Big Pharma may have on the CDC but I would be shocked if there are not similar limitations on research and reporting about GMO foods and chemical/pharmaceutical additives to both animal food and breeding practices.

    In both cases — WHO and CDC — leadership is political for the top two or three layers, with technocrats appearing from those points down. I don’t know any of the players at the top of either, and I’m sure they have sterling credentials. But just a few hours ago I came across this at The Health Care Blog from someone close to the ground willing to be outspoken. This is what he said:

    >>Tom Frieden is a smug, arrogant ass who over-confidence (I presume he was the one whispering sweet nothings in the President’s ear, which was sufficiently teleprompter-like that BHO promptly just regurgitated them) and incompetent messaging and leadership has created anxiety where there did not have to be any.

    From this moment forward, the administration’s spokesperson for Ebola should by Anthony Fauci, of NIAID, who cut his teeth on dealing with AIDs epidemic. For decades, Fauci has a been a confident, articulate, credible leader on dealing with HIV, in the lab, in the media, and with the public. In short, he is everything that Frieden and his CDC keystone cops are not.

    Let Frieden go become an adjunct lecturer on epidemiology and infectious at some second rate school of public health. <<

    That seems harsh, but another commenter agreed with him.

    I, for one, am ready to cut both CDC and WHO some slack, give them more authority, stand back, quit carping and let them do what I'm sure they both really want to do — address this problem as soon as possible with as many resources as possible. As usual, the only people not making mistakes are those doing nothing. If the mistakes we have seen are as bad as it gets, we can count ourselves damn lucky.
    ~~~~~~~~~~~~~~~~

    For crying out loud, will somebody start advancing a few positive suggestions how best to get this outbreak in West Africa under control before it wipes out a country or two and becomes the Twenty-first Century version of the 1918 global Flu outbreak or a repetition of one of history's various plagues. All this blaming and bitching is getting us nowhere.

  64. For those that have expressed the belief it’s Bush’s fault take note of the following:

    “But the CDC has now confirmed that it gave Amber Vinson permission to make a trip to Cleveland.”

    (“The second Dallas nurse diagnosed with Ebola shouldn’t have traveled on a commercial flight due to her exposure to the virus prior to her diagnosis, said Tom Frieden, director of the Centers for Disease Control and Prevention.”)

    In the news media reports Frieden made it sound like he was blaming the nurse for getting on the plane. Earlier they played the blame game on other items. Doesn’t anyone high up in government wear long pants and know how not to continuously blame others when they themselves drop the ball? Blaming others rather than oneself seems to have permeated this administration.

  65. Passports are easily traceable. Itineraries are known also. Not saying it will be easy. But it will be easier than shaking off a case of ebola and certainly better than establishing whatever leads to endemic-ness.

  66. Peter1, we need not quarantine anyone. Perhaps we should try for primary protection and not let anyone in that comes from or was in the infected areas unless they are American citizens.

  67. “Oh, Peter, is that your gratuitous slap at the idea that we cannot profile? What bull***.”

    Vik, you have a wonderful way with words. You hit the nail on the head.

  68. “you don’t fly unless you’re screened.”

    Screened how? Do you propose we quarantine all those travelers? Where and how would they be quarantined?

    From all the 1000s of people who travel in the world we’ve had ONE, count, ONE, traveller with ebola enter this country.

    A little over reactionary are we Vic?

  69. Just start with the countries experiencing the worst of the outbreak. Start with the planes leaving those countries. Start with the passengers from known high activity areas. If it comes down to it, draw a line down the center of each ocean and get used to localism. International travel is not a given.

  70. Oh, Peter, is that your gratuitous slap at the idea that we cannot profile? What bull***.

    Anyone traveling to the US whose itinerary took them through or brought them from West Africa. Anyone with a West African surname. Anyone who is not of West African origin who has been there within the last 30 days and has not been screened and certified healthy.

    Itineraries are digital, trackable, searchable. So track and search them and get in touch with every single person and tell them “you don’t fly unless you’re screened.” Obama foments ridiculous healty policies that screen millions of Americans for diseases they almost certainly don’t have and you don’t think we can screen people who might actually either pose, or be at-risk?

    Create a useful DOES NOT FLY list based on reality not some government contrived figment that creating a toy cop police force at airports and searching grandma at the aiport would prevent terrorism. You know, like we should have done after 9/11. Profile, baby, profile.

  71. Proof, Texas needs to allow worker unions… what the hospital has done to these nurses is no better than Chinese sweat shops.

    Worker Unions should be allowed in EVERY STATE.

  72. Leo: you are absolutely correct in your assessment. This will go down as one of the worst examples ever of leadership on public health. Trifling with Americans’ anxiety about something many of them don’t understand (another part of the debacle laid at the CDC’s doorstep) for the sake of political correctness.

  73. Frieden has been incapable of explaining how keeping the planes going for routine travel is going to do anything other than guarantee transmission. It may go down in history as one of the stupidest decisions of all time. (Although, I hope I am wrong and overreacting). And for what? So the US can look strong and cosmopolitan? So international travel can survive? What the hell happened to the idea of containment? Your local hospital cannot transform overnight into a hot zone style containment facility. It was stupid to think that it could. This is not some pesky superbug like VRE or MRSA. This is a serious threat to the population at large. The feds need to start acting like it. Now is the time to protect your country. Are you up to it or not?

  74. And if Frieden can’t find an adjunct lecturer’s position, I hear FLOTUS’s inane school lunch and hydration initiatives need new dead wood. Maybe he can help me understand why my kid came home one day with the “Fruit” sold to him at his school: sugar covered raisins. A parody of government ineptitude. Frieden will fit right in.

    By the way, if I was in charge, as of 6 am tomorrow, no passenger from the affected parts of West Africa lands on American soil. Anywhere.

  75. Don’t hold back, Vik.
    Tell us how you really feel.

    I don’t know either of these people but my instinct is that we are looking at the place where bureaucrats and technocrats work side by side. The political challenges at the national level are so larded over with money, personalities and lobbying commissions that it’s hard to know what the core issues really are, much less the competence levels.

    I stopped paying attention when Don Berwick and Elizabeth Warren both got blacklisted by this do-nothing Congress. After that I presume anybody still standing is more suit than substance. That’s unfair to some of those doing a good job, but durability is about all that’s left this late in the president’s second term.

    Thanks for your input, by the way. You have a way of clarifying a muddy situation.

  76. Agree on Fauci. Dude is spot-on.

    It’s a pass-the-popcorn EHRbola/#Obola/GOPbola kind of day. Mass national Code Brown psychosis looms. All we need are a few more vectors.

  77. Tom Frieden is a smug, arrogant ass who over-confidence (I presume he was the one whispering sweet nothings in the President’s ear, which was sufficiently teleprompter-like that BHO promptly just regurgitated them) and incompetent messaging and leadership has created anxiety where there did not have to be any.

    From this moment forward, the administration’s spokesperson for Ebola should by Anthony Fauci, of NIAID, who cut his teeth on dealing with AIDs epidemic. For decades, Fauci has a been a confident, articulate, credible leader on dealing with HIV, in the lab, in the media, and with the public. In short, he is everything that Frieden and his CDC keystone cops are not.

    Let Frieden go become an adjunct lecturer on epidemiology and infectious at some second rate school of public health.

  78. State’s rights – we have the right to fight ebola ourselves with a plan that is developed in and by the needs of each state. Oh, and please send federal funds to help us pay for this.

  79. Gee, Governor Perry, and Senator Cruz, what’s the problem? Isn’t the government yet sufficiently weak and fund-starved to effectively fight Ebola?

  80. Peter1, anyone who has read a newspaper and comments by the CDC are in a position to make the statement I made.

    Duncan called the CDC and the CDC advised him to go to a hospital. The CDC knows hospitals are unprepared for such problems and should have immediately sent someone down there. They should have called the hospital and provided instructions because unless one has dealt with this type of problem before they are not fully prepared.

    We have paid big bucks for two hospitals to be built specifically for the care of such patients. To date the CDC has been providing political reassurance. Today they decided to ship the newest patient to one of those facilities.

    Keeping things sterile is a lot more difficult than people imagine. Gupta from CNN on the net demonstrated where the problems occur when taking a gown off. The gowns being used are not satisfactory for this type of threat.

    Take note the CDC uses different technologies and methodologies to prevent its staff from becoming infected. Even the staff cleaning the sidewalk outside of the first nurses home had better protection.

    The nurses have a right to be angry and should direct some of that anger towards the CDC.

  81. The CDC and anything else of federal origin is always “behind the curve.” The chorus of government-can’t-do-anything-right, too-many-government-regulations and the impulse to privatize everything in sight has taught national figures to walk on eggs every time they leave the office lest they tread on some hypersensitive state or local toes.

    The states rights chickens have come home to roost as state, local and private-sector parties responsible scapegoat the feds. You can’t have it both ways. Responsibility and authority go hand in hand. CDC guidance is just that — guidance. Their authority, like all federal authority, is circumscribed by limitations jealously guarded by the states. Federal authorities have learned to respect those boundaries. The Supreme Court left ACA largely unmolested — but allowed states to opt out of expanding Medicaid. That is a perfect illustration of how those boundaries work.

    Even now CDC is shouldering a good share of “blame” being dished out for the fragility of a federal system in the face of a national threat. Somebody needs to thank hard core states rights, Tenth Amendment, Tea Party activists for filling the air with anti-government smoke just when effective federal action is needed most.

    This is an argument that needs to be dropped. Attention should be directed at stopping the spread of Ebola where the threat is still out of control.

    Anthony Banbury addressed Security Council members via video link from Accra, Ghana. He called for more money to build treatment centres and for more medical personnel to staff them.

    It follows the WHO’s latest projections suggesting the infection rate could reach 5,000 to 10,000 new cases a week within two months if global efforts to combat the spread of infection were not stepped up.

    There have been 8,914 cases overall, including the fatal cases, and the WHO says it expects this number to top 9,000 by the end of the week. The WHO estimates its figures by taking the numbers of confirmed cases and multiplying them – from Guinea by 1.5, from Sierra Leone by 2 and from Liberia by 2.5 – to account for under-reporting.

    WHO assistant director-general Bruce Aylward said on Tuesday that the rate of infections appeared to be slowing in the “historic epicentre” of the outbreak, but warned that it was too early to read this as success.

  82. Thanks for the address. I think a lot of poorly thought out comments existed at that site.

    I’ll withhold further comments for the appropriate blog.

  83. “This business where the CDC provides excuses instead of action is something that is not reassuring.”

    “Based upon your comments I don’t think you are in the position to make such a statement.”

  84. Guys : this is interesting, but getting a bit off topic. Post going up later today on the Deb Peel / EPIC story. Can we take the thread on this one there, please?

  85. Bobby, do you have the address for “Why did Mr. Duncan have to die for the US to face flaws in EHRs”?

  86. “Letting a tool drive process is where the problem lies”

    Tool? Karen DeSalvo? Jonathan Bush? . . . Oh, you mean the EHR.

  87. True.

    It was a process failure, of which an EHR designed for data mining and charge capture, not patient care, was a big part. For docs, the EHR is just the most visible representation of a medical care system that has pretty much gone completely off the rails.

  88. According to what I have heard from physicians all over the place the EHR is a distraction. If that is the case then at the very least the EHR contributed to the problem. There is only so much information that can be processed by the ER doctor and Apparently the EHR can disrupt the thinking process and normal communications.

  89. Peel is the national HIT Privacy Scold, I have known of and followed her your years. She’s nominally an “MD,” but she’s a psychiatrist, not an ER doc.

    She’s an alarmist.

  90. You called Peel an alarmist. I don’t know her so I don’t know one way or the other, but perhaps you ought to stop criticizing others until you are on the right page.

  91. It looks like the CDC is behind the curve. Since the CDC was aware there was a problem why weren’t they initially involved even if only by phone?

    The CDC seems to be behind the curve with the second nurse at the Dallas hospital. Since it was already known that the hospital’s preparedness for Ebola was lacking one would think they would be more prepared for a second possible case among those initial nurses. Instead she was flying and the CDC’s response is action was taken 90 minutes after the temperature was taken. Why was she on the plane in the first place. The recommendation to take temperatures I believe is twice per day so we do not know how many hours she was actually running such a temperature and if she were running such a temperature on the plane.

    This business where the CDC provides excuses instead of action is something that is not reassuring.

  92. Straw man.

    The concerns about EPIC were about the failure to diagnose at Mr. Duncan’s first ER visit.

  93. And, this is all EPIC’s fault precisely how? 😉

    The ever-hyperpartisan alarmist Deborah C. Peel MD has a post up on LinkedIn entitled “Why did Mr. Duncan have to die for the US to face flaws in EHRs?”

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